Surgical experience improves the long-term results of Nissen fundoplication

Background: Nissen fundoplication relieves symptoms of gastro-oesophageal r eflux and effectively heals oesophagitis. During long-term follow-up some c ases of recurrent reflux are seen. We investigated the possibility that lon g-term cure of gastro-oesophageal reflux after fundoplication is influenced by the surgeon's experience and focused interest, in line with results of surgery for rectal, gastric, and breast cancer. Methods. One hundred and fi ve consecutive patients were evaluated a median of 77 months after open Nis sen-Rossetti fundoplication for erosive oesophagitis. Follow-up included pe rsonal interviews and upper gastrointestinal endoscopy by an investigator n ot previously involved in the patients' treatment. The surgeons were classi fied as experienced (>10 of the operations in the series), less experienced (<10 operations), or trainees. Results: Of the most experienced surgeons' patients, 97% had no or at most mild reflux symptoms at follow-up, compared with 88% of the of less experienced surgeons' patients (P = 0.04). Healing of erosive oesophagitis was commoner when the operations were performed by experienced specialist surgeons (88% versus 72%; P=0.04). The reoperation rate fell as the surgeons' experience increased, from 12% to 4%. Conclusion s: Surgery for gastro-oesophageal reflux should be centralized to units spe cializing in the techniques and with sufficient annual numbers of operation s to optimize results. This policy becomes especially advisable as laparosc opic surgery increases the numbers of treated patients.